The Long-Tail of Innovation: Customizing Health Care Based on Patient Genetics

One of the hottest trends for modern innovation is customization of products and services to meet the unique needs of individuals. Classic examples of business model innovation based on customization include Dell computer, who developed a suite of patented supply chain advances to assist in rapidly delivering customized computers at low cost, or Netflix, whose supply chain and Internet-based services allow users to select from vast numbers of movies that could never be housed in a local brick and mortar store. Now IT-related businesses including eBay and hundreds of others are increasingly taking advantage of Internet tools, database systems, cookies and other ways of tracking customer preferences and patterns to provide customized offerings to appeal to the unique needs and wants of individuals.

The next frontier for innovation based on customization will be health care. Some think this is already happening now that health records can be electronic and advanced diagnostic tools and databases can be applied to meet patient needs, but in reality, much of health care is still based on old models of “one or two sizes fit all.” What is the right medication for a patient? In what dose? Body weight, age, and gender may be considered in writing a prescription, but there are many other factors that need to be considered, including genetics. Understanding the relationship between drugs and individual genetics represents an important frontier for innovation in medicine. Today I’d like to highlight one important example of successful research in this field.

Recently in Singapore, while speaking at an Innovation and Enterprise Week, I met keynote speaker Dr. Michael Hayden of the University of British Columbia’s Center for Molecular Medicine and Therapeutics. (Not the same Michael Hayden who was a director of the CIA.) Dr. Hayden was recently named Canada’s Researcher of the Year. In his speech, Dr. Hayden spoke of his quest to understand the mysteries of disease and to reveal their genetic roots to thereby develop better approaches to treatment for patients. One exciting breakthrough that he mentioned, arising from collaboration with others at UBC and beyond, is the discovery that the terrible side effect of deafness that strikes many cancer patients on chemotherapy can be predicted with DNA testing. The popular and highly effective drug, cisplatin, is the problem. By understanding the relationship to genetics, high-risk patients can be identified and alternate medications can be prescribed. Finding genetic links to adverse drug reactions is a major step forward toward treatments that really match the unique nature of each patient.

A week after my encounter with Dr. Hayden in Singapore, I was in Mexico City’s large international airport, standing in a line, when I overheard the man behind me telling someone about his clinical work with cancer patients, and the discovery that genetics played a role in determining whether the patient would be at risk for deafness. My curiosity was aroused, so I couldn’t resist the temptation to interrupt and ask the man if he was from the University of British Columbia by any chance. Yes, in fact, he was. This was Dr. Bruce Carleton, a peer of Dr. Michael Hayden whom Dr. Hayden had mentioned in Singapore. What a small world it can be when I pay attention and reach out to others! We discussed his work briefly and I expressed my excitement at what they are doing. Today he kindly sent me a copy of his recent publication on the cisplatin work, published in the prestigious journal Nature Genetics. The publication is “Genetic variants in TPMT and COMT are associated with hearing loss in children receiving cisplatin chemotherapy” by J.D. Colin,  Hagit Katzov-Eckert, Marie-Pierre Dubé, Beth Brooks, S. Rod Rassekh, Amina Barhdadi, Yassamin Feroz-Zada, Henk Visscher, Andrew M. K. Brown, Michael J. Rieder, Paul C Rogers, Michael S Phillips, Bruce C Carleton, Michael R. Hayden & the CPNDS Consortium, Nov. 2009. Here is the abstract:

Cisplatin is a widely used and effective chemotherapeutic agent, although its use is restricted by the high incidence of irreversible ototoxicity associated with it1. In children, cisplatin ototoxicity is a serious and pervasive problem, affecting more than 60% of those receiving cisplatin2–5 and compromising language and cognitive development. Candidate gene studies have previously reported associations of cisplatin ototoxicity with genetic variants in the genes encoding glutathione S-transferases and megalin6–8. We report association analyses for 220 drug-metabolism genes in genetic susceptibility to cisplatin-induced hearing loss in children. We genotyped 1,949 SNPs in these candidate genes in an initial cohort of 54 children treated in pediatric oncology units, with replication in a second cohort of 112 children recruited through a national surveillance network for adverse drug reactions in Canada. We identified genetic variants in TPMT (rs12201199, P value = 0.00022, OR = 17.0, 95% CI 2.3–125.9) and COMT (rs9332377, P value = 0.00018, OR = 5.5, 95% CI 1.9–15.9) associated with cisplatin-induced hearing loss in children.

Watch for genotyping of patients coupled with extensive research on genetics and drug performance to become a pillar for health care innovation in the future. Customization of care at many other levels can be expected as well, as long as incentives for innovation in health care remain healthy.

Congratulations to Drs. Carleton and Hayden and their partners for outstanding work that will drive further innovation in how patients are treated.

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